Synopsis of Neuropsychiatry

Synopsis of Neuropsychiatry

SC Yudofsky and RE Hales, editors

Washington DC: American Psychiatric Press; 1994. 641 p

This paperback is a synopsis of the American Psychiatric Press Textbook of Neuropsychiatry, which was first published in 1987 (a second edition has subsequently been published). The Synopsis of Neuropsychiatry is designed to condense most chapters from the second edition, and its content is aimed at medical students and residents in psychiatry and neurology.

The book is divided into 5 sections: the basic principles of neuroscience, neuropsychiatric assessment, neuropsychiatric symptomatologies, neuropsychiatric disorders, and neuropsychiatric treatments.

The section on basic principles of neuroscience includes chapters on cellular and molecular biology of the neuron, and on human electrophysiology. The chapter by Daniel Tranel on functional neuroanatomy from a neuropsychological perspective is particularly well done. These chapters are all well organized and plentiful diagrams add interest and clarity.

The neuropsychiatric assessment section includes chapters on bedside neuropsychiatry, neuropsychological evaluation, electrodiagnostic techniques, brain imaging, and epidemiology and genetics. The chapter on bedside neuropsychiatry by Fred Ovsiew is an excellent summary of the major symptoms and signs of neuropsychiatric disorders. The chapters on electrodiagnostic techniques and brain imaging are also good overviews. I found the chapter on epidemiology and genetics too technical when describing linkage analysis and molecular approaches to the investigation of various neuropsychiatric diseases such as Huntington’s Disease and schizophrenia.

The third section on neuropsychiatric symptomatologies includes chapters on differential diagnosis in neuropsychiatry, neuropsychiatric aspects of pain management, and delirium. Chapters on neuropsychiatric aspects of aphasia and related language impairments, and neuropsychiatric aspects of memory and amnesia are also part of this section. The chapter on differential diagnosis by Richard Strub and Michael Wise has an excellent algorithm on the approach to the patient with memory loss, as well as an informative and concise table on common focal behavioral syndromes and their localization. The chapter on pain management by William Brouse and David Spiegel focusses on neurological mechanisms of pain and neuropharmacology but could be more clinically oriented. Delirium is well covered by Michael Wise and George Brandt. Frank Benson provides a superb chapter on aphasia, which presents a complicated topic clearly and succinctly. The chapter on neuropsychiatric aspects of memory and amnesia by Arthur Shimamura and Felicia Gershberg describes the neural and biochemical mechanisms of memory very well, and outlines some clinical syndromes. However, it would benefit by a section on the differential diagnosis and investigation of the patient with memory disturbance.

The next section has 12 chapters on specific neuropsychiatric disorders: traumatic brain injury, epilepsy, sleep, cerebral vascular disorders, brain tumors, human immunodeficiency virus, endocrine disorders, poisonous and toxic disorders, alcohol-induced organic mental disorders, degenerative dementias associated with motor dysfunction, Alzheimer’s Disease and other dementias, and the neuropsychiatry of schizophrenia. There are particularly comprehensive and clinically focussed chapters on sleep (by Thomas Neylan, Charles Reynolds and David Kupfer), cerebral vascular disorders (by Sergio Starkstein and Robert Robinson), Alzheimer’s Disease (by Jeffrey Cummings), and the neuropsychiatry of schizophrenia by Henry Nasrallah. There is little, in any chapter, written on the neuropsychiatric aspects of multiple sclerosis despite its prevalence. Other missing topics include autistic disorders and mental retardation, neuropsychiatric aspects of street drug abuse, and chronic fatigue syndrome.

The final section on neuropsychiatric treatments includes chapters on psychopharmacological treatment in neuropsychiatry, psychotherapy for neuropsychiatric disorders, cognitive rehabilitation and behavior therapy, stress and coping in family caregivers, and ethical and legal issues in neuropsychiatry. The chapter on psychopharmacology by Steven Dubovsky is comprehensive and well organized. I found the chapter on psychotherapy too long and wordy, although the tables nicely summarize the lengthy discussion in the text. The chapter on cognitive rehabilitation and behavior therapy by Mark Lovell and Christopher Starratt is a well-written overview, and serves as a good introduction to this topic. Stress and coping in family caregivers is covered mostly by discussing theorical models with little attention to clinical issues. Ethical and legal issues in neuropsychiatry are well covered in the chapter by Robert Simon.

Overall, this is a strong textbook which provides a solid overview of neuropsychiatry. The authors are all recognized neuropsychiatry experts. Every chapter is well referenced, which enables the reader to investigate any topic in more depth, if necessary. A strength of almost every chapter is the liberal use of tables, diagrams and figures. Unfortunately, several chapters contain diagrams and figures that require colour to be useful, such as figures of PET and SPECT scans. The reader is referred to The American Psychiatric Press Textbook of Neuropsychiatry, second edition, for full-color figures. This is extremely irritating, and it is unlikely that many readers will have ready access to the larger textbook when reading this chapter, thus losing the benefit of illustrations. I suggest that the publisher consider adding full-color figures even if it increases the cost of the Synopsis of Neuropsychiatry.

This book will be very useful for residents in psychiatry, particularly during a rotation in consultation-liaison psychiatry, and also for neurology residents and neuropsychology interns. Medical students will benefit from this book during their rotations in psychiatry and neurology. It will also be useful to clinical psychiatrists involved in inpatient and consultation-liaison psychiatry, although other textbooks will be necessary if an indepth look into a particular area is desired.